Washington state ahead of the curve on health-care reform

Funny how things change in politics. By the time voters cast ballots for president, the label Obamacare went from a pejorative to a point of pride.

Americans saw the 2010 Affordable Care Act making changes in their lives, and any enthusiasm for repeal was eroding.

Republicans eventually gave up trash-talking the health reforms because they had nothing to offer the 30 million Americans without insurance or those who were delighted with the improved coverage the law provided them.

The elimination of industry gimmicks to deny or limit coverage and the inclusion of young adults on their parent’s policy to age 26 were a huge hit.

State Sen. Karen Keiser, D-Kent, returned last week from a series of legislative briefings in Washington, D.C., with a determined optimism that the new health-care law would be launched as planned in January 2014.

Keiser chairs the Senate Health & Long-Term Care Committee. She and her counterpart in the House, state Rep. Eileen Cody, D-West Seattle, have worked for years to improve access to health care for Washington residents.

Washington and a handful of other states, including California and Maryland, sped ahead with establishing the exchanges that will begin enrolling consumers in October 2013, with coverage to start in January.

Washington’s exchange picked up a new name last month. It will operate as the Washington Healthplanfinder, which will offer online guidance and side-by-side comparisons of coverage and costs.

Keiser was struck by the absolute determination of key federal players to get everyone started. She heard from Gary Cohen, director of the Center for Consumer Information and Insurance Oversight, and Cindy Mann, director of the Centers for Medicaid and Medicare Service.

Cohen will oversee implementation of the Affordable Care Act, which will, among other things, subsidize health-insurance coverage for small businesses.

Mann’s piece will cover insurance for those under age 65 whose incomes are below 133 percent of the federal poverty line. States will be subsidized at 100 percent for three years, and 90 percent thereafter.

Lots of states have been in ideological paralysis for the past two years. Some legislatures would not budge, even as governors expressed interest in Obamacare. In other places lawmakers wanted to move ahead and governors balked.

A few Republican governors have said they will simply let the federal government set up the whole system in their state. Keiser muses about the possibility of a federal plan for recalcitrant states becoming a template for a national health-care system.

Keiser’s legislative instincts are already looking ahead to the next set of challenges: cost controls, and transparency for services provided and their expense. Vendors and hospitals are on notice.

“We must get our arms around what we are paying for,” Keiser said. “We do not get accurate information.”

She blames arcane accounting systems, and looks to savings with standardized billing procedures and the spread of electronic record keeping. “This issue of cost will explode,” Keiser said.

Washington’s early preparation was rewarded with federal grants to create its insurance exchange, help doctors, clinics and hospitals install electronic medical records, and encourage colleges and universities to train health-care professionals.

Insurance companies are not complaining about the flood of new business they will get or the chance to recover the costs of preventive care over the course of healthier lives.

Keiser and Cody helped get Washington ready to benefit from a plan even its former political foes are quietly lining up to use.